CPT code 43219 is a medical billing code used for esophagus endoscopy procedures, helping healthcare providers accurately document and bill for services.
CPT code 43219 is for an esophagogastroduodenoscopy (EGD) procedure, which involves the examination of the esophagus, stomach, and the beginning of the small intestine (duodenum) using a flexible tube with a camera. This code is specifically used when the procedure is performed with or without biopsy, and it helps healthcare providers document and bill for the diagnostic evaluation of conditions affecting these upper gastrointestinal structures.
When billing for CPT code 43219 (Esophagus endoscopy), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in surgery.
14. Modifier GC - This service has been performed in part by a resident under the direction of a teaching physician: Used in teaching settings where a resident is involved in the procedure.
15. Modifier QK - Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals: Used when an anesthesiologist is directing multiple procedures.
16. Modifier QS - Monitored anesthesia care service: Used to indicate monitored anesthesia care.
17. Modifier QX - CRNA service with medical direction by a physician: Used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia under the direction of a physician.
18. Modifier QY - Medical direction of one CRNA by an anesthesiologist: Used when an anesthesiologist directs one CRNA.
19. Modifier QZ - CRNA service without medical direction by a physician: Used when a CRNA provides anesthesia without the direction of a physician.
These modifiers help provide additional information about the circumstances under which the esophagus endoscopy was performed, ensuring accurate billing and reimbursement.
CPT code 43219 is reimbursed by Medicare. The code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) and local coverage determinations. Providers should consult their regional MAC for specific coverage and payment information related to this CPT code.
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